With the vigorous development of the medical and health cause in China, the management of medical institutions by classification has become an objective requirement. It is imperative to combine the subjective basis and the objective basis and make a scientific distinction between non for profit and for profit hospitals. It is also important to use for reference international experience in this aspect and determine the rational proportion of the two kinds; to earnestly solve problems in understanding the reclassification and change the governments functions in managing the medical and health cause; and to strive for preferential policies so as to create a sound social environment for the transformation of public hospitals into for profit ones. Only by vigorously and steadily transforming existing public medical institutions by classification can a new system of management of medical institutions by classification be established in due course.

Defibrillators, Implantable ; Electric Countershock ; Humans ; Ventricular Fibrillation

Objective:To develop the Chinese version of measuring change in restriction of salt (sodium ) in diet in hypertensives(MCRSDH), and to test its reliability and validity.Methods:Authorization was obtained from the original authors of MCRSDH.Cross-cultural revision of the MCRSDH was conducted according to the guidelines from November 2020 to January 2021.Totally 700 patients with hypertension were recruited through convenience sampling from 4 community health service centers in 2 main urban districts of Changsha and investigated by the Chinese version of MCRSDH.Reliability and validity of the scale were assessed.Results:The correlation coefficient between each item and the total score ranged from 0.327-0.799 and 0.468-0.893 in MCRSDH initiation (MCRSDH-INIT)and MCRSDH sustenance(MCRSDH-SUST) respectively.The item of content validity index(I-CVI) of each item ranged from 0.802 to 1.000, and the scale of content validity index(S-CVI) was 0.914.Four factors were extracted by exploratory factor analysis(EFA)and could explain 68.511% of the total variance for MCRSDH-INIT.Three factors were extracted by EFA and could explain 76.558% of the total variance for MCRSDH-SUST.Values of factor loading ranged from 0.541 to 0.926 for MCRSDH-INIT, and from 0.586 to 0.888 for MCRSDH-SUST.The Confirmatory factor analysis indicated that χ 2/ df=1.732, GFI=0.902, CFI=0.945, RMSEA=0.046, NFI=0.931, TLI=0.936 for initiation model and χ 2/ df=1.248, GFI=0.937, CFI=0.971, RMSEA=0.018, NFI=0.943, TLI=0.937 for sustenance model.The cronbach's α coefficient of the scale was 0.901 and the test-retest reliability was 0.917. Conclusion:The Chinese version of the MCRSDH is reliable and valid, and can be used as a tool to MCRSDH in China.

Objective To evaluate the significance of AFP-IgM, this is one of new tumor markers, in the diagnosis of primary hepatocellular carcinoma (PHC). Methods The contents of AFP-IgM and AFP in serum of 103 healthy subjects, 74 patients suffered primary hepatic carcinoma, 27 patients affected by liver cirrhosis and 63 patients affected by chronic hepatitis were detected by means of enzyme linked immunosorbent assay and electrochemiluminescence. No-PHC is comprised of liver cirrhosis,chronic hepatitis and health subjects as control group. Results The area under ROC curve of AFP was larger than that of AFP-IgM (0.85 vs 0.72, Z=3.21) and the best cut-off value of AFP-IgM and AFP was 3×105-AU/L and 10 ug/L respectively, which was determined by ROC curve. Under the cut-off value, the sensitivity of AFP- lgM and AFP for PHC were 64.9% and 79.7%, and the specificity were 75.6% and 80.3%, yet their efficacies were similar. However, for early diagnosis of liver cancer (stage Ⅰ and Ⅱ), the area under ROC curve of AFP-IgM was larger than that of AFP (0.91 vs 0.82,Z=1.73). The sensitivity of AFP-IgM andAFP were 94.4% and 72. 2%, and the specificity were 81.9% and 79.9%. The differences of AFP-IgMand AFP for early diagnosis of liver cancer were statistically significant. When both of the test results combined AFP-IgM with AFP are positive, it can be diagnosed as liver cancer. The specificity of combineddetermination of the two forms was 89.1%, and the efficacy was 79. 0%. Conclusions Both of thesensitivity and specificity of the AFP-IgM test were higher than that of the AFP for early diagnosis of livercancer. We also found that combined determination of the two forms significantly increased the specificityand the positive predictive value for the diagnosis of PHC, thus AFP-IgM was of especially significance forearly diagnosis of liver cancer.

Objective To study the treatment effects of newborn mice murine Cytomegalovirus (MCMV) hepatitis by using CpG Oligodeoxynucleotide 2395 (CpG ODN2395).Methods Specific pathogen-free BALB/c newborn mice were divided into 3 groups according to the broods randomly:control group,virus group and treatment group.In control group 9 g/L sodium chloride 20 × 10-6 L was intraperitoneally injected every other day.In virus group MCMV (TCID50 =108.31/L) 20 × 10-6 L was intraperitoneally injected once and 9 g/L sodium chloride solution 20 × 10-6 L was intraperitoneally injected every other day.In treatment group murine MCMV(TCID50 =10S31/L) 20 × 10-6 L was intraperitoneally injected once and from the first day CpG ODN2395 20 mg/kg was intraperitoneally injected every other day.Growths and development of mice were observed.Murine body weights were measured.Pathology of livers was observed by means of hematoxylin and eosin stain.The levels of serum ALT and IFN-α were measured by adopting enzyme linked immunosorbent assay.MCMV loads in liver were measured by way of polymerase chain reaction.The expression levels of IFN-α mRNA in liver were detected by using reverse transcription polymerase chain reaction.The expression levels of Toll-like receptor 9 (TLR9) and myeloid cell differentiation factor 88 (MyD88) in liver were detected by adopting Western blot.The results were analyzed by using SPSS 16.0 statistics software.Results 1.Compared with control group and treatment group,growth and development of virus group mice fell behind and on day 7,14 body weights were lowest(F =18.919,25.543,all P ＜ 0.05).Growth and development of treatment group mice were between control group and virus group.Body weights of treatment group mice were lower than those of control group,and there was statistical difference on day 7 (t =3.187,P ＜ 0.05).2.Compared with control group and treatment group,the levels of ALT in virus group was highest.ALT levels of treatment group were higher than those of control group and treatment group(F =11.407,11.791,154.656,all P ＜ 0.05).3.The pathologic change of liver tissue:the HAI of virus group reached the peak on day 3,then decreased gradually.The HAI of treatment group also reached the peak on day 3,but liver damage was obviously less than those of virus group.The liver damage also relieved gradually and the mean of HAI was obviously lower than that of virus group on day 7 and 14.4.MCMV DNA in liver was negative at control group.The magnitude of viral loading in livers of virus group was higher than that of treatment group.5.The levels of IFN-α in treatment group and virus group reached a peak on day 3 and declined gradually on day 7,14.The levels of IFN-α on treatment group were higher than that of virus group and control group.The levels of IFN-α virus group were higher than those of control group,but had no statistical difference.6.The mRNA expression of IFN-α in livers of treatment group and virus group began to increase on day 3 and reached a peak on day 7,and declined on day 14.The mRNA expression of IFN-α was higher than that of virus group and control group.The mRNA expression of virus group was higher than that of control group.7.The expressions of TLR9 and MyD88 in livers of treatment group were higher than that of virus group and control group.The expressions of TLR9 and MyD88 of virus group were higher than those of control group.Conclusions CpG ODN2395 can obviously improved liver function and histopathological lesions and reduce MCMV DNA load within liver tissues as well.CpG ODN2395 can improve the expression levels of TLR9 in liver and activate secretion interferon alpha by MyD88-dependent pathway,which were likely to play an important role in its treatment of murine CMV infection.

Objective:To compare the diagnostic efficacy of 68Ga-prostate specific membrane antigen (PSMA)-11 PET/CT and 18F-fluorodeoxyglucose (FDG) PET/CT in TNM staging before radical prostatectomy. Methods:From July 2018 to December 2019, a total of 67 patients ((67.5±6.8) years) with prostate cancer diagnosed pathologically by radical surgery in Renji Hospital, School of Medicine, Shanghai Jiao Tong University were retrospectively enrolled. All patients underwent 68Ga-PSMA-11 PET/CT and 18F-FDG PET/CT whole-body scans before surgery. Results of PET/CT were compared with pathological diagnosis after surgery to compare the diagnostic efficiencies of 68Ga-PSMA-11 PET/CT and 18F-FDG PET/CT for preoperative TNM staging ( χ2 test). The differences of the maximum standardized uptake value (SUV max) in primary lesions between 2 imaging methods were compared by Mann-Whitney U test. Patients were divided into low-risk, intermediate-risk and high-risk for stratified analysis. Results:Among 67 patients, 9 were with low-risk, 19 were with intermediate-risk, 39 were with high-risk. For T staging, 59 (88.06%, 59/67) patients showed positive results by 68Ga-PSMA-11 PET/CT imaging, with median SUV max of 13.80(7.30, 22.40) for 67 patients; 31(46.27%, 31/67) patients showed positive results in 18F-FDG PET/CT imaging, with median SUV max of 4.00(3.10, 5.60) ( U=62, P<0.05). Stratifed analysis showed that the detection rate of 68Ga-PSMA-11 PET/CT was higher than that of 18F-FDG PET/CT in intermediate-risk patients (17/19 vs 6/19; χ2=4.920, P<0.05). Among 67 patients, 10 were diagnosed as N1 stage based on the pathological results. The sensitivities, specificities, accuracies, positive predictive values and negative predictive values of 68Ga-PSMA-11 PET/CT and 18F-FDG PET/CT for detecting positive regional lymph nodes were 6/10, 87.72%(50/57), 83.58%(56/67), 6/13, 92.59%(50/54) and 4/10, 89.47%(51/57), 82.09%(55/67), 4/10, 89.47%(51/57), respectively. 68Ga-PSMA-11 PET/CT detected 15 patients (22.39%, 15/67) with M1 stage, and 18F-FDG PET/CT identified 9 patients (13.43%, 9/67; χ2=35.436, P<0.05). Conclusions:As for T staging, the detection rate of 68Ga-PSMA-11 PET/CT in the intermediate-risk group is better than 18F-FDG PET/CT. In N and M staging, the detection rates of 68Ga-PSMA-11 PET/CT are higher than those of 18F-FDG PET/CT.

OBJECTIVE: To assess the practical and health economical values of non-invasive prenatal test (NIPT) in Changsha Municipal Public Welfare Program. METHODS: A retrospective analysis was carried out on 149 165 women undergoing NIPT test from April 9, 2018 to December 31, 2019. For pregnant women with high risks, invasive prenatal diagnosis and follow-up of pregnancy outcome were conducted. The cost-benefit of NIPT for Down syndrome was analyzed. RESULTS: NIPT was carried out for 149 165 pregnant women and succeeded in 148 749 cases (99.72%), for which outcome were available in 148 538 (99.86%). 90% of pregnant women from the region accepted the screening with NIPT. 415 (0.27%) were diagnosed as high risk. Among these, 381 (91.81%) accepted amniocentesis, which led to the diagnosis of 212 cases of trisomy 21 (PPV=85.14%), 41 cases with trisomy 18 (PPV=48.81%) and 10 cases with trisomy 13 (PPV=20.83%). The sensitivity and specificity of NIPT for trisomy 21, trisomy 18 and trisomy 13 were (97.70%, 99.98%), (97.62%, 9.97%) and (100%, 99.97%), respectively. In addition, 213 and 30 cases were diagnosed with sex chromosomal aneuploidies (PPV=46.2%) and other autosomal anomalies (PPV=16.57%), respectively. For Down syndrome screening, the cost and benefit of the project was 120.79 million yuan and 1,056.95 million yuan, respectively. The cost-benefit ratio was 1: 8.75, and safety index was 0.0035. CONCLUSION NIPT is a highly accurate screening test for trisomy 21, which was followed by trisomy 18 and sex chromosomal aneuploidies, while it was less accurate for other autosomal aneuploidies. The application of NIPT screening has a high health economical value.
Aneuploidy ; Cost-Benefit Analysis ; Female ; Humans ; Noninvasive Prenatal Testing ; Pregnancy ; Retrospective Studies ; Trisomy 18 Syndrome/genetics*